The psychologist's role in assessing and facilitating patients' knowledge of advance directives in medical settings: A preliminary investigation

In a time of budgetary shortfalls in the medical industry, an aging population, and an increased emphasis on health care choices, psychologists are being called upon to administer advance medical directive programs to patients. This study reports preliminary findings from a program to assess and facilitate patients' knowledge of advance directives (ADs) by the Psychology Service at the Ann Arbor VA Medical Center. The participant pool included 243 male veteran patients admitted to medical and surgical wards at the hospital. The intervention included the use of a computer-generated prompt for consultation, which was sent to the psychology staff in response to a patient inquiry regarding ADs. It also involved an increased emphasis on the delivery of written material on ADs by the admissions clerks. The intervention appeared to result in a modest increase in patients' knowledge of advance directives. Suggestions are offered for areas that should be emphasized in future attempts to increase patients' knowledge and utilization of advance directives.     

Electrode placement,EMG feedback,and relaxation for tension headaches

Fifteen tension headache subjects were allocated to one of three groups: direct EMG feedback (from a site corresponding to the source of pain), indirect EMG feedback (from a site not corresponding to the source of the pain) and relaxation instructions. There were two base-line, six treatment and one post-treatment sessions. No significant differences were found between base-line and post-treatment EMG levels, for any of the groups; however, some significant reductions in levels were obtained within sessions. EMG levels recorded during headache attacks did not differ significantly from levels recorded during base-line. Frequency and intensity of headaches were significantly reduced, particularly in the relaxation group. At follow-up this improvement was maintained for subjects with forehead pain, but differences between the groups had disappeared.     

Behavioral coaching in the development of skills in football, gymnastics, and tennis

A review of the literature indicates that methods of skill acquisition based on the operant paradigm have been scientifically validated with many motor behaviors. However, these procedures have been limited to the use of positive reinforcement for correct performance when applied to the acquisition of complex sports skills in natural settings. To find complementary procedures to enhance skill acquisition, a coaching method involving several behavioral techniques was developed that focused on remediation of errors. This coaching method combined the following components: (1) systematic use of verbal instructions and feedback, (2) positive and negative reinforcement, (3) positive practice, and (4) time out. Three sports, football, gymnastics, and tennis, were selected to determine the effectiveness and generality of this behavioral coaching method. A total of 23 male and female subjects, ranging in age from 11 to 35, was included in this study. Baseline data were first collected for each sport under standard coaching conditions. Next, the behavioral coaching method was evaluated depending on the sport in either a multiple baseline or a reversal design. The behavioral dimensions selected were blocking in football; backward walkovers, front hand springs, and reverse kips in gymnastics; and the forehand, backhand, and serve in tennis. Behavioral coaching was immediately effective in increasing the correct execution of complex skills in all three sports. Gains of up to 10 times the baseline performance were achieved in each sport. In football, behavioral coaching resulted in an increase in correct blocking performance from a baseline average of 5% to 51.3%. Gymnasts' performances increased from baseline averages of 2.7% to 52.6% across the three skills. In tennis, standard coaching produced an average of 6% correct performance which increased dramatically under behavioral coaching to 57% across the three strokes. The success of the behavioral coaching package used here suggests that a technology of behavior may offer additional and complementary strategies to the acquisition of motor skills in the natural environment.     

Consequence analysis: Its effects on verbal statements about an environmental project

Typically, citizens lack relevant information concerning possible consequences of proposed environmental projects. Despite federal requirements for citizen participation in decisions about proposed roadway projects, no systematic procedures exist for educating citizens as to the possible consequences of such projects. The effects of a consequence analysis procedure on community residents' verbal statements about the favorability of a proposed roadway project were assessed. The consequence analysis procedure involved asking residents to rate the desirability and magnitude of each of 48 possible consequences of the proposed roadway project. Following the intervention, overall ratings of favorability of the project changed for nine of ten residents. Community residents' ratings of the quality of participants' justifications of their position on the roadway issue provided evidence of generalization to this collateral behavior.     

On knowing how well one is remembering: The persistence of strategy use during transfer

A potential cause for children's failure to transfer learning strategies was explored in the present study. A self-monitoring process was suggested to be essential for evaluating one's own level of performance and the effectiveness of various mnemonic strategies. Matched on free recall scores in this study's first sort-and-recall phase, first, third, and fifth graders (ages 7, 9, and 11 years, respectively) were assigned to one of three treatment groups or a control group. During Phase II, the treatment groups received instruction in sorting pictures according to semantic similarities in preparation for future recall. In addition, Groups 3 and 4 later received feedback indicating their Phase II improvement in performance. A cause-and-effect relationship between strategy use and enhanced recall was further suggested to Group 4. Among third graders, only those provided with feedback and strategy instruction continued to rely upon the input organization strategy when faced with transfer tasks in Phase III. Both enhanced recall and improved sorting styles were observed for these subjects in Phase III. Some first graders also showed improved sorting styles and improved recall following feedback, while fifth graders showed enhanced recall even without experimenter-provided feedback. Subject's responses to a metamemory interview provided additional support for the hypothesis that the self-monitoring of memory performance is more likely to be part of fifth graders' (than first graders') memory abilities.     

Essential independence and likelihood-based ability estimation for polytomous items

A definition ofessential independence is proposed for sequences of polytomous items. For items satisfying the reasonable assumption that the expected amount of credit awarded increases with examinee ability, we develop a theory ofessential unidimensionality which closely parallels that of Stout. Essentially unidimensional item sequences can be shown to have a unique (up to change-of-scale) dominant underlying trait, which can be consistently estimated by a monotone transformation of the sum of the item scores. In more general polytomous-response latent trait models (with or without ordered responses), anM-estimator based upon maximum likelihood may be shown to be consistent for under essentially unidimensional violations of local independence and a variety of monotonicity/identifiability conditions. A rigorous proof of this fact is given, and the standard error of the estimator is explored. These results suggest that ability estimation methods that rely on the summation form of the log likelihood under local independence should generally be robust under essential independence, but standard errors may vary greatly from what is usually expected, depending on the degree of departure from local independence. An index of departure from local independence is also proposed.This work was supported in part by Office of Naval Research Grant N00014-87-K-0277 and National Science Foundation Grant NSF-DMS-88-02556. The author is grateful to William F. Stout for many helpful comments, and to an anonymous reviewer for raising the questions addressed in section 2. A preliminary version of section 6 appeared in the author's Ph.D. thesis.     

The conflicts of postmodern and traditional epistemologies in curricular reform: A dialogue

A radical opponent of Western higher education asserts that its pedagogy and content depend on belief in objective truth and knowledge. This epistemology and education are attacked as exclusive and domineering toward women, minorities, and non-Westerners. The critic puts forward a pragmatist epistemology, leading to multi-cultural education aimed at social criticism and personal autonomy. The critic's dialogue with a defender of traditional epistemological ideas provides a critical introduction to the claims justifying many radical criticisms of Western curricula and pedagogy.     

Humanizing education: Subjective and objective aspects

I propose that there are four standards to be met if a given educational enterprise is to be considered humane: (1) the practice to be mastered must be socially justified; (2) the disciplines pursued to master the practice must be appropriate to the practice; (3) the practice must be owned by the learner; and (4) this ownership must itself meet certain ethical requirements. The paper emphasizes the problem of ownership. It argues for a view of ownership that is communitarian. This view sees ownership as a function of identification or membership. People become committed to certain educational ends in virtue of the fact that they see themselves as members of a group and the ends as the ends of the group. It is central to this view that ownership of ends does not require full understanding or rational appraisal of such ends. I argue that a rational appraisal of ends is difficult when a novice seeks to appraise the ends of some practice both because the ends of the practice are internal to it in a way that makes grasping such ends difficult prior to mastery of the practice and because initiation into the practice will change the individual's standards of appraisal.